Trends of Hysterectomy in Tertiary Care Teaching Hospital Batticaloa
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2017, Vol 5, Issue 11
Abstract
Abstract: The aim of this study is to analyze indications and types of hysterectomies done in teaching hospital, Batticaloa.It was a retrospective study in which the detailed analysis of demographic data of the patients, surgical indications and route of surgery of the patients undergoing hysterectomy in five year (June 2012 -June 2017) in teaching hospital,Batticaloa .Out of the total 1090 cases of hysterectomy performed in teaching hospital Batticaloa, the incidence of abdominal hysterectomy was significantly higher (73% vs.27%, p<0.05) than the vaginal hysterectomy.Fibroid uterus was the most common indication for hysterectomy in the study group and Pelvic organ prolapse was the second most common cause for hysterectomy.Adenomyosis, ovarian mass, dysfunctional uterine bleeding, uterine lesions other than fibroid,chronic pelvic pain and cervical intraepithelial neoplasia were the other indications. Considerable number of hysterectomies was performed for obstetric causes mostly for post-partum haemorrhage (29, 2.7%).Abdominal hysterectomy was the commonest (73%) surgery performed. 27% of hysterectomies were performed by the vaginal route. The most common indication for the hysterectomy was uterine fibroid.Although hysterectomy is a definite solution for symptomatic fibroids, alternative treatment for fibroids and uterine bleeding should be considered. In future, Ulipristal acetate can contribute to reduce hysterectomy.Non-descent vaginal hysterectomy (NDVH) is a feasible option for benign gynaecological conditions with a uterus less than 14 weeks in size.Hysterectomy for benign condition can be better managed with levonorgestrel releasing system (LNG-IUS) and endometrial ablation (EA). If steps are taken to make wider availability, rate of hysterectomy can be reduced further.Considerable numbers of hysterectomies were also performed for mostly for post-partum hemorrhage .Conservative management strategies can be encouraged initially to its rate.In pelvic organ prolapse, uterus sparing surgery in the form of mesh repair can reduce hysterectomy for pelvic organ prolapse .The cost of the mesh limits its usage in our low resource setting. This study shows that 36.1% of women who underwent abdominal hysterectomy also underwent concurrent BSO. Even though the principal motivation for the BSO is to reduce subsequent ovarian malignancy, the benefit must be balanced against the effects of premature withdrawal of ovarian hormones. The underutilized minimal invasive techniques must be made more available in our setting. Keywords:Hysterectomy, Vaginal hysterectomy, Pelvic organ prolapse.
Authors and Affiliations
Thirukumar M
Keywords
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